I'm an IMG but I'm American. I've just graduated this year and have to do my USMLE exams. Anyway, throughout the entirety of medical school I had no idea what I wanted to do. Now after graduating, I'm very much set on dermatology. Its always been in the back of my head, but I was exploring other options such as psychiatry, general internal medicine, paediatrics, etc. I know a dermatology residency is very competitive. I have no publications as previously stated. Is it mainly based on USMLE scores (I heard minimum you should be getting 240)? Anything I could do to improve my chances?
Would appreciate your thoughts!
I would focus your efforts elsewhere. I say this kindly and respectfully, with no intention of hurting your feelings, but I had two good friends who were US-IMGs who both made the same mistake. They took years (in one case 2 years!) off to research/make connections. They busted their tails for years, were prolific researchers, and made connections with the right people. It didn't help them. Neither matched after multiple tries.
Having sat on the other side of the admissions process, I have better perspective than I did as an applicant. Look at it from their perspective - you get 100 applications on your desk (this is after most of the applications have been filtered out). You have 3 residency slots to give away. Maybe 3-4 of the apps have lower Step 1s (below 240) that made it through for various interesting reasons - a well connected LoR, a truly noteworthy research project, etc. For most residencies, no DO or US-IMG applications will make it through the pile. There may be 1-2 FMGs (true foreigners) who have made it through because of dedicated research time and connections with the right people.
Now out of the rest of the stack, you're looking at 90+ USMD applicants, all of whom score above 240 (probably 70% of whom are above 250) with substantial publications, strong letters, and many of whom come from medical schools with top derm programs (and therefore have some true bigwig letters attached to their name).
Now can you start to see why it's such an uphill battle? The odds are so stacked against you that it's not even worth trying for, because the amount of time you would spend doing dermatology research (we're talking at least a dedicated year of research) would be better spent elsewhere. For just about every residency program, your application won't even make it through the initial screen.
For a dermatology residency program, a US IMG would fall lower on the totem pole than a true foreign grad, because being American and going abroad comes with its own baggage (I'm not getting into that debate here, but for the purposes of derm residency directors, it's true). Unfortunately when you make the decision as an American to go abroad for medical school, it comes with consequences, and the inability to match into certain fields like dermatology is one of them.
So I'd recommend exploring other fields - you sound like you have varied interests - peds, IM, and psychiatry. All could be reasonable depending on your scores. Best of luck with the application cycle.
